Decreasing Door-to-Analgesia Time: Increasing Use of Sickle Cell Pain Management Pathway

Individuals living with sickle cell disease often experience episodes of acute pain, prompting them to seek care in the emergency department. These patients frequently encounter prolonged wait times and invasive procedures before receiving analgesia. This evidence-based quality improvement project aimed to enhance the timely management of sickle cell-related pain by increasing adherence to an existing pain management pathway. The initiative focuses on promoting the use of intranasal fentaNYL as a first-line analgesic.

To promote consistent use of the established pathway, multiple interventions were implemented. These included a standard operating procedure to promote safe use of intranasal fentaNYL, a best practice advisory in the electronic health record prompting staff to notify a physician for an intranasal fentaNYL order, the development of a quick-reference badge card, and the creation of educational materials for patients and families addressing the safety and benefits of intranasal fentaNYL use.

The amount of time before pain medicine administration for the preintervention group varied from 12 minutes to 244 minutes. Administration of pain medication in the postintervention period showed a narrower spread: values ranged from 9 minutes to 193 minutes. Comparing the 2 groups, the mean time to pain medication administration dropped from 82.2 to 67.7 minutes and the median time to pain medication decreased from 65 to 59. These findings may have clinical implications; however, the change did not reach statistical significance (P = .2201).

This quality improvement initiative demonstrated that increased use of a pre-established intranasal fentaNYL protocol yielded a reduction in time to opioid administration for pediatric patients with sickle cell disease in vaso-occlusive crises. These results align with existing literature emphasizing the benefits of standardized pain pathways in improving efficiency and equity in practice.